Self-reported Pain Levels Research Articles

Feasibility and safety of two weeks of blood flow restriction exercise in individuals with spinal cord injury

Context Reduced muscle strength and function are common after spinal cord injury (SCI). While low-load blood flow restriction exercise (BFRE) enhances muscle strength in healthy and clinical populations, its safety and feasibility in individuals with SCI remain underexplored. Objectives To investigate the feasibility and safety of low-load BFRE in individuals with incomplete SCI. Study Design Case series. Setting SCI rehabilitation center. Participants Six participants with motor incomplete SCI were enrolled in the study. Intervention A two-week BFRE intervention for the lower limbs was conducted twice weekly at 40% total arterial occlusion pressure, using 30-40% of 1-repetition maximum loads. Outcome Measures Feasibility measures, specifically recruitment and eligibility rates and intervention acceptability, were collected. Blood pressure (BP) responses and specific coagulation markers for deep vein thrombosis (DVT) were assessed as safety measures. Results Recruitment and eligibility rates were 2.8% and 6.6% for individuals admitted for first-time rehabilitation (subacute SCI) and 8.3% and 13.9% for 4-week readmission rehabilitation stays (chronic SCI), respectively. Intervention acceptability was high, characterized by 95.8% training adherence and low-to-moderate self-reported pain levels. BP responses and changes in C-reactive protein, Fibrinogen, and D-dimer during the intervention remained within clinically acceptable levels. Conclusion BFRE was feasible in an SCI rehabilitation setting despite a low recruitment rate. BFRE imposed no heightened risk of DVT or severe BP fluctuations in the present case series. Additionally, no severe adverse events occurred, and only mild complaints were reported. More extensive safety considerations warrant larger-scale exploration. Trial registration ClinicalTrials.gov identifier: NCT03690700.

Early implementation of MAK robotic device in total knee arthroplasty rehabilitation: A proof-of-concept study.

Effective rehabilitation following total knee arthroplasty (TKA) is crucial for enhancing both range of motion (ROM) and functional outcomes. While robotics has demonstrated its potential in various medical contexts, the evidence on its application in TKA rehabilitation is still scarce. The marsi active knee (MAK), a robotic device that has already proven to be safe and beneficial in people with neurological disease, has been tested to facilitate the rehabilitation of TKA patients. This study aims to evaluate the safety, patient satisfaction, and clinical impact of integrating the MAK into an early rehabilitation regimen for TKA patients. The intervention comprised 14 one-hour sessions administered thrice a week, utilizing the MAK within 48h post-TKA surgery. The rehabilitation sessions incorporated exercises involving passive mobilizations, sit-to-stand transitions, and gait training. Comprehensive data encompassing safety parameters, patient satisfaction, and clinical outcomes were meticulously collected and analyzed. Six participants successfully completed the rehabilitation protocol with the MAK device. Notably, no significant adverse events were documented. Application of the device corresponded to perceptible reductions in self-reported pain levels. Vital signs remained within minimal variance pre- and post-rehabilitation. Participants proficiently engaged in all assisted exercises facilitated by the device, culminating in a high overall satisfaction rating of 4.6±0.5 out of 5. The findings indicate that the MAK device exhibits a commendable level of safety while obtaining considerable patient satisfaction during the early rehabilitation phase following TKA, suggesting this device may be a reliable adjunct to TKA protocols.

Analyzing deep textual facial patterns for human pain sentiment recognition system in smart healthcare framework

BACKGROUND: Patient sentiment analysis aids in identifying issue areas, timely remediation, and improved patient care by the healthcare professional. The relationship between pain management and patient sentiment analysis is crucial to providing patients with high-quality medical care. Therefore, a self-reported pain level assessment is required for the smart healthcare framework to determine the best course of treatment. OBJECTIVE: An efficient method for a pain sentiment recognition system has been proposed based on the analysis of human facial emotion patterns of patients in the smart healthcare framework. METHODS: The proposed system has been implemented in four phases: (i) in the first phase, the facial regions of the observation patient have been detected using the computer vision-based face detection technique; (ii) in the second phase, the extracted facial regions are analyzed using deep learning based feature representation techniques to extract discriminant and crucial facial features to analyze the level of pain emotion of patient; (iii) the level of pain emotions belongs from macro to micro facial expressions, so, some advanced feature tunning and representation techniques are built along with deep learning based features such as to distinguish low to high pain emotions among the patients in the third phase of the implementation, (iv) finally, the performance of the proposed system is enhanced using the score fusion techniques applied on the obtained deep pain recognition models for the smart healthcare framework. RESULTS: The performance of the proposed system has been tested using two standard facial pain benchmark databases, the UNBC-McMaster shoulder pain expression archive dataset and the BioVid Heat Pain Dataset, and the results are compared with some existing state-of-the-art methods employed in this research area. CONCLUSIONS: From extensive experiments and comparative studies, it has been concluded that the proposed pain sentiment recognition system performs remarkably well compared to the other pain recognition systems for the smart healthcare framework.

The Association of Medical Cannabis Use with Pain Levels and Opioid Use in Illinois’ Opioid Alternative Pilot Program

Objective The state of Illinois’ Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. Methods A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. Results A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. Conclusions Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes.

Misdiagnosis or Missed Diagnosis - Hallux Sesamoid Fractures among Active-Duty Females in the United States Air Force: A Case Series

Background: Female service members tend to have a higher level of foot injuries than males. The United States Army spent $103 million in 2017 on fractures in toes and feet. Fractures of the tibial and fibular sesamoids are problem that often can be nonspecific, mainly related to pain at the plantar aspect of the first metatarsal head without an obvious traumatic event. Anatomic variation in these sesamoids exist after ossification which results in the possibility of multipartite sesamoids. Of the multipartite sesamoids, bipartite sesamoids are the relatively common and tripartite sesamoids are quite rare. The overall prevalence of bipartite sesamoids is presumed to be between 7 and 30%, with a majority occurring bilaterally. Methods: We completed a case series on three female active-duty Airmen. All three patients were active with their pain beginning following activity. All three were subsequently misdiagnosed, resulting in at least 6 months of pain prior to diagnosis and treatment. Results: Plain film radiography and subsequent imaging confirmed the diagnosis of a tibial or fibular sesamoid fracture. Following conservative treatment all three patients made a full recovery as confirmed by imaging and self-reported pain levels and they were able to return to full activity. Conclusion: Providers should keep a sesamoid fracture in the differential diagnosis when evaluating active female patients with pain in the area around the base of the great toe, especially in women in the military and others that may do higher levels of physical activity compared to the average patient. While the diagnosis of sesamoid fractures can be challenging, it is standard practice to obtain multiple views if using plain film radiography. Magnetic resonance imaging, weightbearing computed tomography and bone scans can be useful confirmatory studies.

Homeopathy for Chronic Non-specific Low Back Pain: Study Protocol for a Randomized, Double-Blind, Crossover, Placebo-Controlled Clinical Trial Investigating the Efficacy of the Biotherapic Lumbar Vertebra (The BIOVERT Trial).

Chronic non-specific low back pain (CNSLBP) lacks identifiable anatomical pathology and effective pharmacological treatment. Alternative approaches in homeopathy, specifically clinical homeopathy, utilize ultra-diluted (potentized) biological products. In Brazil, standardized biotherapics from sheep tissues, particularly fifty-millesimal (LM) potencies of sheep Lumbar Vertebra, have shown promise in alleviating CNSLBP. Our objective is to present the study protocol of a clinical trial that will assess the efficacy and safety of the biotherapic Lumbar Vertebra LM2 in the short-term management of CNSLBP and to estimate its therapeutic duration. A randomized, double-blind, crossover, placebo-controlled clinical trial spanning 8 weeks per participant was designed. Participants will include 120 individuals (aged 20 to 60 years) with clinically diagnosed CNSLBP by the study's physiotherapist. Exclusion criteria are radicular pain, signs of radiculopathy, specific lumbar spine disorders, pregnancy, or puerperium (up to 60 days after delivery). The medical intervention includes participants being randomly assigned to one of two treatment sequences: homeopathy-placebo or placebo-homeopathy. The treatments will consist of Lumbar Vertebra LM2 oral solution, topical cream, and indistinguishable placebos. Each treatment period will span 2 weeks, with a 4-week washout interval between them. Primary outcome is the assessment of changes in self-reported pain levels using the numeric rating scale (NRS) score, analyzed with a random effects model across both treatment periods. Secondary outcomes are assessment of changes in self-reported disability levels using the Oswestry Disability Index (ODI), analyzed with a random effects model across both treatment periods, and pain and disability variations, evaluated by the NRS score and ODI respectively, after the first and second treatment periods. Adverse events will be assessed at weeks 2 and 8. Pain medications will be used concomitantly. Adherence will be evaluated by the weight of medication returned/standard weight. The BIOVERT (Bioactive Vertebra) trial protocol is designed to investigate a homeopathic strategy for short-term CNSLBP treatment. Favorable outcomes for homeopathy could prompt subsequent studies evaluating the long-term effectiveness of LM potencies of Lumbar Vertebra for CNSLBP. UMIN Clinical Trials Registry - ID: UMIN000051957.

Self-reported pain during different phases of orthodontic treatment with fixed appliance: A multi-centre randomized controlled trial in adolescents with crowding.

To compare self-reported pain levels across various treatment phases using passive self-ligating (Damon) and conventional (Victory) standardized fixed appliance systems. Adolescents (12-17 years old) with crowding and displaced teeth, planned for non-extraction treatment, were recruited from four orthodontic clinics. They were randomized into stratified blocks (1:1 ratio) using concealed allocation to receive Damon Q™ (34 boys, 28 girls) or Victory™ (39 boys, 31 girls). Pain and analgesic intake were assessed on seven different occasions with validated self-report questionnaires using a 10-grade scale. Of the 132 patients included, six were lost to follow up. Clinically relevant mean pain scores (≥4) were registered in both groups after bonding upper and lower arches and after insertion of 0.019 × 0.025 stainless steel archwire. The highest mean scores were reported on day two after bonding the upper arch (Damon 5.96, Victory 7.18, P = .011). In both groups, at least 40% reported taking analgesics during various treatment phases. The Damon group reported a lower intake of analgesics on days one and two (P = .042 and .037) after treatment initiation. In the entire sample, boys reported significantly higher mean pain scores than girls on the second and third days after bonding (P = .008 and .026, respectively). Lower pain levels were reported from the Damon group after bonding. In general, boys reported higher pain than girls did. Clinicians and adolescents need to be aware that clinically relevant pain levels can be expected not only after bonding but also in later phases.

Scapular muscle endurance, shoulder pain, and functionality in patients with rotator-cuff-related shoulder pain: a matched, case-control study.

Deficiency in scapular muscle endurance (SME) is a risk factor for rotator-cuff-related shoulder pain (RCRSP). However, the exact relationship among SME, pain, and functionality remains unclear. This study aims to compare SME, pain, and functionality in RCRSP patients to those in age-sex-matched healthy controls. Twenty-three patients with RCRSP and 23 age-sex matched healthy controls were included in the study. SME was measured using a 1-kg dynamometer. Self-reported pain level was assessed using a visual analog scale. The Functional Impairment Test-Hand, Neck, Shoulder, and Arm (FIT-HaNSA) was also used to assess functional impairment. The control group had higher SME and total FIT-HaNSA scores than the patient group (P<0.05). There was a statistically significant and positive correlation between SME and FIT-HaNSA scores in both groups (P<0.05). SME was affected by RCRSP. Pain and functional impairment were correlated with low SME. Level of evidence: IV.

Efficacy of Novel Bracing for Treating Sciatica and Cadaveric Dissection to Examine Excursion of the Sciatic Nerve

Background/Objective:Sciatica affects nearly half of all Americans and can often become debilitating, leading to severe pain that can limit performing activities of daily living. Brace application has not been tried for alleviation of pain. In this study, we seek to find if a novel brace can decrease pain and decrease bothersome level of symptoms for those suffering from sciatica. In addition, this study utilizes a cadaveric dissection to understand how the sciatic nerve stretches and tensions upon lower limb manipulation.&#x0D; Methods:Fourteen patients self-reported pain, functionality, and bothersome levels pre- and post-bracing. Excel’s data analysis tool was utilized to run statistical tests. One cadaver (2 lower limbs) was dissected, revealing the sciatic nerve at the hip and knee, while tibial nerve at the ankle. Excursion was measured utilizing a fixed pin and an initial distance, the leg manipulated, and final distance from pin measured. Ultimately, excursion was deemed final distance minus initial distance from the pin.&#x0D; Results:The brace decreases Visual Analogue Scale (VAS) scores, increases Patient Reported Outcomes, and decreases Sciatica Bothersome Indexes. There was a significant difference in VAS pre- versus post-brace values at initial and 7-day post-visit but not at 21- or 42-day postvisit. Sciatic nerve excursion was greatest at the ankle.&#x0D; Conclusion and Potential Impact:Brace use decreases pain levels, increases functionality, and decreases bothersome level of symptoms. The distal nerve moves more upon manipulation and therefore is more prone to tensioning than the proximal nerve. Dissection data illustrates how the brace positions the limb in a way that promotes “detensioning” of the nerve, alleviating sciatica. More cadaver data is needed.

Diurnal Pain Classification in Critically Ill Patients using Machine Learning on Accelerometry and Analgesic Data.

Quantifying pain in patients admitted to intensive care units (ICUs) is challenging due to the increased prevalence of communication barriers in this patient population. Previous research has posited a positive correlation between pain and physical activity in critically ill patients. In this study, we advance this hypothesis by building machine learning classifiers to examine the ability of accelerometer data collected from daily wearables to predict self-reported pain levels experienced by patients in the ICU. We trained multiple Machine Learning (ML) models, including Logistic Regression, CatBoost, and XG-Boost, on statistical features extracted from the accelerometer data combined with previous pain measurements and patient demographics. Following previous studies that showed a change in pain sensitivity in ICU patients at night, we performed the task of pain classification separately for daytime and nighttime pain reports. In the pain versus no-pain classification setting, logistic regression gave the best classifier in daytime (AUC: 0.72, F1-score: 0.72), and CatBoost gave the best classifier at nighttime (AUC: 0.82, F1-score: 0.82). Performance of logistic regression dropped to 0.61 AUC, 0.62 F1-score (mild vs. moderate pain, nighttime), and CatBoost's performance was similarly affected with 0.61 AUC, 0.60 F1-score (moderate vs. severe pain, daytime). The inclusion of analgesic information benefited the classification between moderate and severe pain. SHAP analysis was conducted to find the most significant features in each setting. It assigned the highest importance to accelerometer-related features on all evaluated settings but also showed the contribution of the other features such as age and medications in specific contexts. In conclusion, accelerometer data combined with patient demographics and previous pain measurements can be used to screen painful from painless episodes in the ICU and can be combined with analgesic information to provide moderate classification between painful episodes of different severities.

High Self-Reported Levels of Pain 1 Year After a Myocardial Infarction Are Related to Long-Term All-Cause Mortality: A SWEDEHEART Study Including 18 376 Patients.

Background Pain increases the risk for cardiovascular diseases, including myocardial infarction (MI). However, the impact of pain on mortality after MI has not yet been investigated in large studies with long-term follow-up periods. Thus, we aimed to examine various levels of pain severity 1 year after an MI as a potential risk for all-cause mortality. Methods and Results We collected data from 18 376 patients, aged <75 years, who had a registered MI event during the period from 2004 to 2013 and with measurements of potential cardiovascular risk indicators at hospital discharge from the Swedish quality register SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). Self-reported levels of experienced pain according to EuroQol-5 dimension instrument were recorded in secondary prevention clinics 1 year after hospital discharge. We collected all-cause mortality data up to 8.5 years (median, 3.4 years) after the 1-year visit. The Cox proportional hazard regression was used to estimate hazard ratio (HR) and 95% CI. Moderate pain and extreme pain were reported by 38.2% and 4.5%, respectively, of included patients. There were 1067 deaths. Adjusted HR was 1.35 (95% CI, 1.18-1.55) and 2.06 (95% CI, 1.63-2.60) for moderate and extreme pain, respectively. Pain was a stronger mortality predictor than smoking. Conclusions Pain 1 year after MI is highly prevalent, and its effect on mortality 1 year after MI was found to be more pronounced than smoking. Clinicians managing patients after MI should recognize the need to consider experienced pain when making prognosis or treatment decisions.

Objective wearable measures correlate with self-reported chronic pain levels in people with spinal cord stimulation systems

Spinal Cord Stimulation (SCS) is a well-established therapy for treating chronic pain. However, perceived treatment response to SCS therapy may vary among people with chronic pain due to diverse needs and backgrounds. Patient Reported Outcomes (PROs) from standard survey questions do not provide the full picture of what has happened to a patient since their last visit, and digital PROs require patients to visit an app or otherwise regularly engage with software. This study aims to assess the feasibility of using digital biomarkers collected from wearables during SCS treatment to predict pain and PRO outcomes. Twenty participants with chronic pain were recruited and implanted with SCS. During the six months of the study, activity and physiological metrics were collected and data from 15 participants was used to develop a machine learning pipeline to objectively predict pain levels and categories of PRO measures. The model reached an accuracy of 0.768 ± 0.012 in predicting the pain intensity of mild, moderate, and severe. Feature importance analysis showed that digital biomarkers from the smartwatch such as heart rate, heart rate variability, step count, and stand time can contribute to modeling different aspects of pain. The results of the study suggest that wearable biomarkers can be used to predict therapy outcomes in people with chronic pain, enabling continuous, real-time monitoring of patients during the use of implanted therapies.

Educational intervention promotes injury prevention adherence in club collegiate men's lacrosse athletes.

Club sports are intercollegiate athletics that are student-led and not university-funded, many of which are without professional credentialing. Collegiate club athletes have an increased rate of injury compared to their NCAA counterparts. Education and implementation of stretching and strength training have demonstrated decreased rates of noncontact injuries. Educational intervention was given to club collegiate athletes to determine its effect on injury rates, perceived pain, and compliance toward injury-prevention practices. Intramural collegiate athletes were educated on injury prevention that focused on targeted stretching. Surveys designed to assess the impact of the education were distributed to three men's club lacrosse teams in Utah at the beginning and end of the season. The questions measured pain and time missed due to noncontact injury. Two-tailed unpaired t tests demonstrated p values <0.05 for: overall decreased levels of pain (p<0.0001); increased range of motion (ROM, p<0.0001); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001); decreased pain levels for the hamstring (p=0.0274); and increased frequency of stretching after practice (p<0.0001). The increased frequency of stretching suggests increased compliance toward injury prevention practices. Decreased self-reported levels of overall pain, and decreased pain in the hamstring, show that the subjects surveyed in the sample reported less pain and increased time stretching at the end of the season compared with the beginning of the season. Educational intervention offers an affordable measure to provide club collegiate athletes with resources to reduce injury rates through athlete compliance to targeted stretches.

Poster 178: Outcomes of SLAP Repair vs. Biceps Tenodesis of SLAP Lesions in Females: A Retrospective Review

Objectives: When surgically managing superior labrum from anterior to posterior (SLAP) tears, there is no consensus on whether SLAP repair or biceps tenodesis yields superior long term outcomes. Additionally, no previous studies have specifically examined outcomes of these procedures in female patients, despite evidence of sex-based differences in recovery following orthopedic surgery. The purpose of this study was to retrospectively compare outcomes after SLAP repair and biceps tenodesis in females. Prior to the start of the study, it was predicted that outcomes between patients who undergo SLAP repair and biceps tenodesis as a treatment will not significantly differ. Methods: Female patients who underwent arthroscopic SLAP repair or biceps tenodesis for treatment of an SLAP lesion between 1/1/2014 and 9/1/2019 at a single institution were retrospectively reviewed. Patients were queried using CPT codes for arthroscopic SLAP repair or biceps tenodesis: for those identified, electronic medical records were reviewed to confirm they met inclusion criteria. Exclusion criteria included: age less than 18 years old at the time of surgery, revision surgery, and concomitant rotator cuff repair at the time of surgery. Patients were contacted at a minimum of two-years post- surgery and asked to complete the standardized American Shoulder and Elbow Surgeons (ASES) score, single assessment numerical evaluation (SANE) survey, and visual analog scale (VAS) for pain. Patients were also given a custom survey assessing return to activity and level of activity following the operation. Patient demographics collected included age at time of surgery, BMI, laterality, and procedure type. Differences in post-operative function between the procedures were assessed using T-tests or Mann- Whitney U tests for numerical data and Chi-Square testing for categorical data. Results: The study included 118 patients. 61 (51.7%) underwent arthroscopic SLAP repair, and 57 (48.3%) underwent open or arthroscopic biceps tenodesis. Comparing demographic data for SLAP repair versus biceps tenodesis groups, mean age was 35.2±8.93 years versus 45.5±10.2 years (p&lt;0.001), mean BMI was 27.5 versus 29.2 (p=0.095), the rates of left shoulder repairs was 30 (50.8%) versus 14 (26.4%), and the rates of right shoulder repairs was 29 (49.2%) versus 39 (73.6%) (p=0.014). Concomitant pathologies were recorded in 68.9% of SLAP repairs and in 88.0% of biceps tenodesis (p=0.030). Concomitant procedures (including bursectomy, capsular release, and acromioplasty) were performed in 74.6% of SLAP repairs and in 92.0% of biceps tenodesis (p=0.033). The two groups showed no differences in two-year ASES scores (81.5 in SLAP repair vs 83.3 in biceps tenodesis, p=0.461), SANE scores (75.6 in SLAP repair vs 79.7 in biceps tenodesis, p=0.344) and VAS scores (20.2 in SLAP repair vs 21.1 in biceps tenodesis, p=0.645). Furthermore, rates of participation in sports prior to surgery was similar (55.4% in SLAP repair vs 42.6% in biceps tenodesis , p=0.251); of those who reported participation prior to surgery, rates of return to participation in sport following surgery was also similar (77.4% in SLAP repair vs 78.3% in biceps tenodesis, p=1.000). Conclusions: This is the first study to evaluate the outcomes of SLAP repair and biceps tenodesis for SLAP lesions in female patients. Female patients who underwent surgical treatment of SLAP lesions with SLAP repair or biceps tenodesis show comparable minimum two-year results with respect to level of function, self-reported pain, and ability to return to sports after these procedures. The incidence of concomitant pathologies and concomitant procedures at the time of SLAP repair and biceps tenodesis differed between the two groups, possibly related to group age disparity. Further research is necessary to define precise treatment indications for this pathology in this specific patient population.

Artificial Intelligence for Automatic Pain Assessment: Research Methods and Perspectives.

Although proper pain evaluation is mandatory for establishing the appropriate therapy, self-reported pain level assessment has several limitations. Data-driven artificial intelligence (AI) methods can be employed for research on automatic pain assessment (APA). The goal is the development of objective, standardized, and generalizable instruments useful for pain assessment in different clinical contexts. The purpose of this article is to discuss the state of the art of research and perspectives on APA applications in both research and clinical scenarios. Principles of AI functioning will be addressed. For narrative purposes, AI-based methods are grouped into behavioral-based approaches and neurophysiology-based pain detection methods. Since pain is generally accompanied by spontaneous facial behaviors, several approaches for APA are based on image classification and feature extraction. Language features through natural language strategies, body postures, and respiratory-derived elements are other investigated behavioral-based approaches. Neurophysiology-based pain detection is obtained through electroencephalography, electromyography, electrodermal activity, and other biosignals. Recent approaches involve multimode strategies by combining behaviors with neurophysiological findings. Concerning methods, early studies were conducted by machine learning algorithms such as support vector machine, decision tree, and random forest classifiers. More recently, artificial neural networks such as convolutional and recurrent neural network algorithms are implemented, even in combination. Collaboration programs involving clinicians and computer scientists must be aimed at structuring and processing robust datasets that can be used in various settings, from acute to different chronic pain conditions. Finally, it is crucial to apply the concepts of explainability and ethics when examining AI applications for pain research and management.

Pressure release technique versus placebo applied to cervical and masticatory muscles in patients with chronic painful myofascial temporomandibular disorder: A randomised clinical trial.

The therapeutic approach to myofascial TMD should focus on pain relief and rehabilitation of function. This study investigated whether pressure release technique (PRT) is effective for reducing pain in people with chronic myofascial temporomandibular disorders (TMD). A single-blinded randomised parallel-group trial, with 3 months follow-up was conducted. A total of 72 patients were randomly allocated to receive PRT or sham PRT. Primary outcome was pain assessed with a visual analogue scale (VAS). Secondary outcomes included pressure pain thresholds (PPTs), range of opening of the mouth (ROM), Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), State-Trait Anxiety Index (STAI) and State-Trait Depression Index (ST-DEP). All parameters were assessed at baseline, at the end of the treatment and at 3 months follow-up. Statistical analysis was performed by ANOVA. There were significant main effects of time, group and interaction between time and group (F ≥ 21.92; p < .001) on VAS pain. Post hoc tests showed a significant reduction in VAS pain scores in the PRT group (≥31.9%; p < .001). Effect sizes were moderate in the PRT group at all follow-up periods (≥1.25 Cohen's d). Also, there were significant effects of time in secondary outcomes (F ≥ 9.65; p < .001), and there were also interactions between time and group (F ≥ 3.82; p < .002) with better effects in the PRT group. The inclusion of PRT to conventional management with occlusal splints and self-care management appears to be effective to improve self-reported levels of pain in patients with chronic myofascial TMD pain. Retrospectively registered (ClinicalTrials.gov: NCT03619889).

Mobility range, level of pain and sleep quality of patients with venous leg ulcers.

This study aimed to compare mobility range, level of pain and sleep quality in patients with venous leg ulcers to age- and gender-matched controls without ulcers. Twenty patients with venous leg ulceration and 20 matched controls each answered a questionnaire, completed the short-physical performance battery, filled in a subject diary and wore a smartwatch for 1 week. The median daily step counts of the ulcer group (3622 steps/day) and the control group (5133 steps/day) were significantly different (P = .017). Significant correlations between total step count and age, duration of physical outdoor activities and scores in the short-physical performance battery were observed in the ulcer group. The scores in the short-physical performance battery were significantly different in both groups (P = .005), indicating weaker physical performance in the ulcer group. The greatest difference in the self-reported level of pain between the two groups was stated during movement. On average, the ulcer group slept shorter by 1 h 38 min (P = .002) and had 0.7 wake phases per night (P = .019) more than the control group. Assessing mobility in patients with venous leg ulcers can be used to develop preventive and interventional concepts to improve and individualise physical therapies.

Implementation of Healing Touch in the Acute Care Setting

Aim -The aim of this quality improvement project was to determine the feasibility of implementing Healing Touch (HT) as a complementary therapy at the bedside and its impact on patient self-reported levels of pain, nausea, and anxiety. Healing Touch is a relaxing, heart-centered, biofield therapy. Healing Touch assists in the creation of a coherent and balanced energy field, which supports one's inherent ability to heal (Anderson et al., 2017). Methods -The project was conducted over a 2-month period (February through March, 2020) on the cardiac unit in a Midwestern, acute care hospital. Prior to the project, staff on the unit received education, which included an overview of HT and project implementation. Healing Touch therapy was available three times a week and performed by a certified HT practitioner. Any patient that gave permission to receive a treatment was considered. Forty-six patients participated. Results -Patients rated their level of pain, nausea and anxiety using a 0 to 10 rating scale pre and post treatment. A paired samples t-test revealed self-reported levels of pain: t(45)=5.35, p<0.01, nausea: t(45)=2.74, p<0.01, and anxiety: t(44)=5.88, p<0.01, significantly decreased following HT therapy. Patients were asked, “In your own words tell me how you feel following the treatment.” and “Would you be interested in receiving a Healing Touch treatment in the future?”. Content analysis of the qualitative descriptive responses indicated patients felt relaxed. Additionally, 87% of participants stated they would like another treatment. The average HT treatment was 17 minutes. Conclusions -Healing Touch had a significant impact on patient pain, nausea and anxiety. Given the average HT treatment time, a dedicated role to provide HT is now being piloted. Reference Anderson, J. G., Anselme L. C., & Hart, L. K. (2017). Foundations and practice of healing touch. Healing Beyond Borders.

Topical cannabidiol is well tolerated in individuals with a history of elite physical performance and chronic lower extremity pain

IntroductionCannabidiol (CBD) is a potential therapeutic for pain management. Yet, there exists a dearth of studies of its tolerability and efficacy, especially in special populations. Former elite athletes are a special population both susceptible to chronic pain and also highly trained and attuned to assess medication tolerability concerns. The purpose of the present open-label pilot study was to assess the tolerability of CBD in this population.Materials and methodsRetrospective analysis was conducted in deidentified data from 20 individuals who were all previously professional athletes in US/American football, track and field, or basketball, with careers ranging from 4 to 10 years. Participants received topical CBD (10 mg twice daily by controlled dispenser) for chronic pain resulting from acute lower extremity injuries. Assessments of tolerability and secondary analyses of pain, pain-related disability, and activities of daily living were collected by self-report over the 6-week study period. Data were analyzed by descriptive statistics, pairwise t-test, and linear regression.ResultsSeventy percent of participants completed the study. Of the individuals who completed the study, 50% reported minor adverse effects, none of which required medical attention, and 50% did not report any adverse effects. The mostly commonly reported effects were skin dryness (43% of study completers) and skin rash (21% of study completers), which rapidly resolved. There was a significant improvement in self-reported pain levels (intake mean 3.5 ± 0.29; exit mean 1.7 ± 0.23; P < 0.001) and pain-related disability, including family and home responsibilities, life support activities, occupational activities, recreational activities, self-care, sexual function, and social activities (all P < 0.001).DiscussionTo the best of our knowledge, this is the first study to assess CBD treatment in elite athletes, who are disproportionally susceptible to disabling injuries. Topical administration of CBD was tolerated well by this population and resulted in only minor adverse effects. As elite athletes are trained and attuned to assess their own bodies due to their professional lives, this population is likely to detect tolerability concerns. However, this study was limited to a convenience sample and self-reported data. These pilot findings warrant further study of topical CBD in randomized and controlled studies of elite athletes.

Fibromyalgia patients with elevated levels of anti-satellite glia cell immunoglobulin G antibodies present with more severe symptoms.

Transferring fibromyalgia patient immunoglobulin G (IgG) to mice induces pain-like behaviour, and fibromyalgia IgG binds mouse and human satellite glia cells (SGCs). These findings suggest that autoantibodies could be part of fibromyalgia pathology. However, it is unknown how frequently fibromyalgia patients have anti-SGC antibodies and how anti-SGC antibodies associate with disease severity. Here, we quantified serum or plasma anti-SGC IgG levels in 2 fibromyalgia cohorts from Sweden and Canada using an indirect immunofluorescence murine cell culture assay. Fibromyalgia serum IgG binding to human SGCs in human dorsal root ganglia tissue sections was also assessed by immunofluorescence. In the cell culture assay, anti-SGC IgG levels were increased in both fibromyalgia cohorts compared with control group. Elevated anti-SGC IgG was associated with higher levels of self-reported pain in both cohorts, and higher fibromyalgia impact questionnaire scores and increased pressure sensitivity in the Swedish cohort. Anti-SGC IgG levels were not associated with fibromyalgia duration. Swedish fibromyalgia (FM) patients were clustered into FM-severe and FM-mild groups, and the FM-severe group had elevated anti-SGC IgG compared with the FM-mild group and control group. Anti-SGC IgG levels detected in culture positively correlated with increased binding to human SGCs. Moreover, the FM-severe group had elevated IgG binding to human SGCs compared with the FM-mild and control groups. These results demonstrate that a subset of fibromyalgia patients have elevated levels of anti-SGC antibodies, and the antibodies are associated with more severe fibromyalgia symptoms. Screening fibromyalgia patients for anti-SGC antibodies could provide a path to personalized treatment options that target autoantibodies and autoantibody production.